At Odds With Others: Hang up the gloves and start talking Thursday, Jan 2 2014 

This article appeared in the March/April 2008 issue of CMA Today the monthly magazine published by the American Association of Medical Assistants (AAMA). It was written by Cathy Sivak.

This article is regarding conflict with others in the office environment and is increasingly a challenge for every office.

“Meaningful conflict actually enhances communications by relating the expectation up front between the parties. Communication can be painful, you may have to correct somebody, but in the end you gain more respect from each other,” says Charlene Burgett, MSHCM, CMA (AAMA), CPC, CMSCS

AT ODDS WITH OTHERS Article CMA Today

Boxing Gloves

Getting ready for the Zombie Apocalypse Tuesday, Mar 12 2013 

Zombie Apocalypse Rescue Team

I am a fan of The Walking Dead show and graphic novels! I love all things Zombie!!  So, when I saw that someone created ICD-10 codes for a Zombie Apocalypse, I was absolutely thrilled!  Here’s the link to see what was dreamed up:

http://www.findacode.com/aprilfools/icd-10-cm-chpt-22-draft.pdf

Enjoy!!!

2012 in review Sunday, Dec 30 2012 

The WordPress.com stats helper monkeys prepared a 2012 annual report for this blog.

Here’s an excerpt:

600 people reached the top of Mt. Everest in 2012. This blog got about 12,000 views in 2012. If every person who reached the top of Mt. Everest viewed this blog, it would have taken 20 years to get that many views.

Click here to see the complete report.

What Insurance Companies Don’t Want You to Know! Friday, Oct 26 2012 

Finally! A long awaited and much anticipated book about ERISA by two well-respected leaders in the health care industry! This book will provide the secrets in getting claims paid, how to fight denials, and halt recoupments using the features within the ERISA regulations.

This is a must buy! Quite frankly, this is important even if you are a layperson covered under your employer’s group health plan! These are the secrets that your insurance company doesn’t want you or your doctor’s office to know!

Book Description

Publication Date: October 15, 2012
New book helps medical practices use the secrets within the ERISA regulations to their benefit to increase practice profitability The Medical Practice Guide to ERISA: Employee Retirement Income Security Act The Federal law ERISA (Employee Retirement Income Security Act) helps the majority of medical practices make carriers pay on claims that are now being denied, delayed and recouped. Only a small percentage of practices understand how ERISA works — yet with this new book, ERISA could possibly become a practice’s best friend! ERISA is complex and most medical practices, “Don’t know what they don’t know when it comes to dealing with ERISA!” Practices are in the dark in understanding how to protect their employer’s rights in collecting the monies owed them. ERISA regulates the practice s health benefits, health benefit payments, EOBs, and most importantly, appeal rights Using this book will allow the reader to not only capture the funds on thousands of dollars that the carriers are now unfairly denying, but will empower the reader to stop the unfair recoupments, illegal timely filing and improper appeal periods that carriers mistakenly quote to physicians and hospital offices. The authors map out the smart but ingeniously simple tactics that practices can use to force insurance carriers to honor their responsibilities on the policies owned by patients — and to convince the carriers to adhere to what the policies actually require them to cover. Providing an overview of the ERISA law, the Self/Verno book provides tips, tools and techniques to leverage ERISA for practice advantage. They take a close look at real-world ERISA situations, violations and outcomes. Armed with this roadmap, physicians and executive staff can better put their resources to work– leveraging ERISA to improve practice profitability. Noteworthy Features Clear Roadmap Written in layman’s terms so practice leaders can immediately begin to implement a strategy of getting claims paid, how to fight denials and halt recoupments. Practical Guidance Includes real world examples and case studies of how medical practices can use the ERISA rules to work for them. Also included is practical information on how to use the ERISA website and answers to the most frequently asked questions about ERISA. Templates to Get You Started Sample letters (describing exact situations and how they can be handled) will get you started and help your practice take control of the process. Selected Table of Contents Healthcare Basics Definitions Laws Employee Benefits Security Administration: Frequently Asked Questions about ERISA Using ERISA Claims Issues Sample Letters – Timely Filing Denial Response, Refund Demand Layperson Response, Unpaid Claims Letter, Incorrectly Paid Claims Letter, Bundling Denial Letter, Down Coding Letter, Payment to Patient Letter Additional Resources – Helpful Websites, Layperson Documents Authorized Representation, Assignment of Benefit Form

You can purchase through Amazon by clicking on this link:

http://www.amazon.com/The-Medical-Practice-Guide-ERISA/dp/0988304007/ref=pd_rhf_cr_p_t_1

OAISYS Call Recording Case Study Tuesday, Oct 2 2012 

A few years ago, I did a video case study for OAISYS on their call recording solutions. I never thought, until now, to include it on my blog…here goes!

http://www.youtube.com/watch?v=R6Ikzy87h5A&feature=plcp

 

 

 

 

ICD-10-CM implementation date is October 1, 2014 Saturday, Sep 1 2012 

The final rule setting the ICD-10-CM implementation date as October 1, 2014 was released by the Centers for Medicare & Medicaid Services (CMS) on August 24, 2012.

Why am I being Charged for my “FREE” physical? Saturday, Sep 1 2012 

Due to the Patient Protection and Affordable Care Act (PPACA), or commonly called “Obamacare”, Health Plans are starting to cover Preventive Medicine services at 100% with no copays, coinsurance or deductible. Unfortunately, insurance companies are not informing patients that dealing with medical issues during these preventive medicine visits will result in an out-of-pocket charge that could result in a co-payment, or a substantial out-of-pocket expense if they have not met their deductible. Insurance companies require all services to be itemized and coded appropriately. One of the primary reasons is to prevent the health plans from paying for services that are not covered. Providers cannot code problem visits as preventive because this would be insurance fraud and could result in the insurance company denying the claim, dropping the physician from their network, and/or, if a government plan, the physician can face imprisonment and fines.

This has resulted in patients becoming angry with their doctor’s offices. Many practices are trying to figure out how to deal with this issue. At my practice, we notify patients before their preventive visit by posting signs on the exam room walls and the medical assistant provides a written notification for the patient to sign that they understand the billing policy. We are also trying to have the physician alert the patient, during the preventive medicine visit, when their concerns become a medical visit and may result in an out-of-pocket expense to the patient. Depending on the severity of the patient’s concern, the physician may be obligated to address the medical issue because, if he didn’t, it could result in a bad outcome for the patient. For example, if the patient states that they have been dizzy and having terrible headaches, this could mean that the patient may have a brain tumor or other significant medical issue. If the physician ignored this complaint, it would harm the patient or could harm others if the patient were driving a vehicle and had an episode. In addition, this would easily become a malpractice lawsuit against the physician.

Some physicians have chosen not to do both a preventive medicine visit and a problem visit on the same day. If the patient is scheduled for a wellness visit and a problem comes up, the physician would either make the decision to change the visit to a problem-oriented visit and reschedule the preventive if the problem is high risk; or have the patient return to deal with the problem issue at a later date if the problem is a low risk. This method keeps the appointments separate and easier for the patient to understand the difference. The downside is that it requires the patient to come back for a second visit, taking additional time off work, to deal with something that could have been handled during one visit.

FOBT (Fecal Occult Blood Testing) Coding Fact Sheet Sunday, Aug 12 2012 

Erica Schwalm graciously allowed me to post her coding fact sheet for Fecal Occult Blood Testing. Thank you, Erica!

“My office was having a lot of billing errors related to billing for FOBTs so I made this coding fact sheet to help everyone (physicians and coders) out!  Perhaps it will be of some use to some of you as well.  82270 can NOT be billed for FOBT done via DRE, but 82272 can…  I was seeing a lot of providers trying to bill 82270 with wellness visits when they shouldn’t have been and then, on the other hand, I found many “problem” FOBT’s (82272) that were never billed for when they should’ve been.”

Erica D. Schwalm, CPC, CPC-GENSG, CMRS

http://www.ericacodes.com

FOBT (Fecal Occult Blood Testing) Coding Fact Sheet 

There are two types of FOBT – Screening (82270) & Diagnostic (82272)

1.  The SCREENING test is covered yearly for those aged 50 and over.  This is a preventive test done in the absence of any signs or symptoms.

The patient is given “Stool Cards” to take home and collect three consecutive specimens.  When complete, the pt sends the cards in for testing.  Once testing is complete, then we can bill for CPT code 82270Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided 3 cards or single triple card for consecutive collection).

We cannot bill for the test when the pt is given the cards, only once they are returned and interpreted.

We cannot bill for screening FOBT when done during a rectal exam because only one sample is tested.  This does not meet the qualification for the code.  This method is considered to be included in the payment for the office visit.

The only acceptable diagnosis for this is V76.51 (Screening for colorectal cancer)

 

2.  The DIAGNOSTIC test is covered when medically necessary for signs & symptoms without regard to patient age or frequency limitations.

The patient may be given “Stool Cards” to take home and collect 1 – 3 specimens.  When complete, the pt sends the cards in for testing. Once testing is complete, then we can bill for CPT code 82272Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening.

In some situations, the physician may perform the test during a rectal exam (e.g. pt comes in c/o abdominal pain and tarry stools, physician would need to know immediately if there is active GI bleed).  Unlike code 82270, this one CAN be billed even when only one specimen is tested.

Do not use a v-code.  Use the sign or symptom(s) that prompted the test (e.g. rectal bleed, abdominal pain, etc.)

Never forget your medication information again! Monday, Jul 2 2012 

Most people have phones with cameras now-a-days. To help remember your medications in an Emergency situation, or even simply when you go to your physicians office, take a close-up picture of the prescription bottle! Try to get the medication name, strength, dosage, and prescribing physician in the picture. In addition, it is helpful to know the pharmacy name, pharmacy telephone number and your prescription number. You can also take pictures of your vitamins, supplements and any over-the counter medications that you take.

Many Smart phones allow you to create files, similar to a computer, where you can create a file called “My Prescriptions” and file each picture of your medication into that file.

HHS PROPOSES ONE-YEAR DELAY OF ICD-10 COMPLIANCE DATE Monday, Apr 9 2012 

For Immediate Release: Monday, April 09, 2012
Contact: CMS Office of Public Affairs
202-690-6145

HHS PROPOSES ONE-YEAR DELAY OF ICD-10 COMPLIANCE DATE

(CMS-0040-P)

Action

The Department of Health and Human Services (HHS) today announced a proposed rule that would delay, from October 1, 2013 to October 1, 2014, the compliance date for the International Classification of Diseases, 10th Edition diagnosis and   procedure codes (ICD-10).

The ICD-10 compliance date change is part of a proposed rule that would adopt a standard for a unique health plan identifier (HPID), adopt a data element that would serve as an “other entity” identifier (OEID), and add a National Provider Identifier (NPI) requirement.   The proposed rule was developed by the Office of E-Health Standards and Services (OESS) as part of its ongoing role, delegated by HHS, to establish adopt standards for electronic health care transactions under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).   OESS is part of the Centers for Medicare & Medicaid Services (CMS).

Background

On January 16, 2009, HHS published a final rule to adopt ICD-10 as the HIPAA standard code sets to replace the previously adopted ICD–9–codes for diagnosis and procedure codes (see HIPAA Administrative Simplification;  Modifications to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS,  74 FR 3328). The compliance date set by the final rule was October 1, 2013.

Implementation of ICD-10 will accommodate new procedures and diagnoses unaccounted for in the ICD-9 code set and allow for greater specificity of diagnosis-related groups and preventive services.  This transition will lead to improved accuracy in reimbursement for medical services, fraud detection, and historical claims and diagnoses analysis for the health care system.  Many researchers have published articles on the far-reaching positive effects of ICD-10 on quality issues, including use of specific reasons for patient non-compliance and detailed procedure information by degree of difficulty, among other benefits.

Some provider groups have expressed serious concerns about their ability to meet the October 1, 2013 compliance date.   Their concerns about the ICD-10 compliance date are based, in part, on implementation issues they have experienced meeting HHS’ compliance deadline for the Associated Standard Committee’s (ASC) X12 Version 5010 standards (Version 5010) for electronic health care transactions.  Compliance with Version 5010 is necessary prior to implementation of ICD-10.

All covered entities must transition to ICD-10 at the same time to ensure a smooth transition to the updated medical data code sets.   Failure of any one industry segment to achieve compliance with ICD-10 would negatively impact all other industry segments and result in rejected claims and provider payment delays.   HHS believes the change in the compliance date for ICD-10, as proposed in this rule, would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition among all industry segments.

Provisions of the proposed rule announced today

HHS is proposing to change the ICD-10 compliance date to October 1, 2014.

As stated, the ICD-10 compliance date change is part of a proposed rule that would adopt a standard for a unique health plan identifier (HPID), adopt a data element that would serve as an “other entity” identifier (OEID), and add a National Provider Identifier (NPI) requirement.

Standards compliance date

HHS proposes that covered entities must be in compliance with ICD-10 on October 1, 2014.

The proposed rule, CMS-0040-P, may be viewed at www.ofr.gov/inspection.aspx.

A news release on the proposed rule may be viewed at http://www.hhs.gov/news.

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